Laparoscopic port assembly

ABSTRACT

Various embodiments of a laparoscopic trocar assembly are disclosed. The port assemblies include inserted parts that protect the patient&#39;s tissues at the point of deployment. The port assemblies include seals for maintaining pneumoperitoneum both when instrument are being used and when instruments are not inserted.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.12/228,445 filed on Aug. 13, 2008, now U.S. Pat. No. 8,911,365, which isa continuation of U.S. patent application Ser. No. 12/079,599 filed onMay 27, 2008, now U.S. Pat. No. 8,888,695, which claims the benefit ofInternational Application Number PCT/US2008/003991 filed on Mar. 27,2008, published as WO 2008/121294 A1, which claims the benefit of U.S.Provisional Patent Application No. 60/920,935 filed Mar. 30, 2007. Thisapplication relates to U.S. patent application Ser. No. 12/228,438 filedon Aug. 13, 2008, now U.S. Pat. No. 8,876,708, and to U.S. patentapplication Ser. No. 12/550,595, which is pending, filed on Aug. 31,2009, and published as US 2010/0113886 A1.

FIELD OF THE INVENTION

The present invention relates to surgical port assemblies. The portassemblies of the present invention are particularly useful in minimallyinvasive surgical procedures such as laparoscopic operations entirelythrough the umbilicus.

BACKGROUND OF THE INVENTION

Abdominal laparoscopic surgery gained popularity in the late 1980's,when benefits of laparoscopic removal of the gallbladder overtraditional (open) operation became evident. Reduced postoperativerecovery time, markedly decreased post-operative pain and woundinfection, and improved cosmetic outcome are well established benefitsof laparoscopic surgery, derived mainly from the ability of laparoscopicsurgeons to perform an operation utilizing smaller incisions of the bodycavity wall.

Laparoscopic procedures generally involve insufflation of the abdominalcavity with gas to a pressure of around 15 mm Hg. The abdominal wall ispierced and a 5-10 mm in diameter straight tubular cannula or trocarsleeve is then inserted into the abdominal cavity. A laparoscopictelescope connected to an operating room monitor is used to visualizethe operative field, and is placed through (one of) the trocarsleeve(s). Laparoscopic instruments (graspers, dissectors, scissors,retractors, etc.) are placed through two or more additional trocarsleeves for the manipulations by the surgeon and surgical assistant(s).

Recently, so-called “mini-laparoscopy” has been introduced utilizing 2-3mm diameter straight trocar sleeves and laparoscopic instruments. Whensuccessful, mini-laparoscopy allows further reduction of abdominal walltrauma and improved cosmesis. However, instruments used formini-laparoscopic procedures are generally more expensive and fragile.Because of their performance limitations, due to their smaller diameter(weak suction-irrigation system, poor durability, decreased videoquality), mini-laparoscopic instruments can generally be used only onselected patients with favorable anatomy (thin cavity wall, fewadhesions, minimal inflammation, etc.). These patients represent a smallpercentage of patients requiring laparoscopic procedure. In addition,smaller, 2-3 mm, incisions may still cause undesirable cosmetic outcomesand wound complications (bleeding, infection, pain, keloid formation,etc.).

Since the benefits of smaller and fewer body cavity incisions areproven, it would be attractive to perform an operation utilizing only asingle incision in the navel. An umbilicus is the thinnest and leastvascularized, and a well-hidden, area of the abdominal wall. Theumbilicus is generally a preferred choice of abdominal cavity entry inlaparoscopic procedures. An umbilical incision can be easily enlarged(in order to eviscerate a larger specimen) without significantlycompromising cosmesis and without increasing the chances of woundcomplications. The placement of two or more standard (straight) cannulasand laparoscopic instruments in the umbilicus, next to each other,creates a so-called “chopstick” effect, which describes interferencebetween the surgeon's hands, between the surgeon's hands and theinstruments, and between the instruments. This interference greatlyreduces the surgeon's ability to perform a described procedure.

Thus, there is a need for instruments and trocar systems, which allowlaparoscopic procedures to be performed entirely through the umbilicuswhile at the same time reducing or eliminating the “chopstick effect.” Alaparoscopic procedure performed entirely through the umbilicus, usingthe laparoscopic instruments and trocar system according to anembodiment of the present invention, allows one to accomplish thenecessary diagnostic and therapeutic tasks while further minimizingabdominal wall trauma and improving cosmesis.

OBJECTS OF THE INVENTION

The present invention provides cannula or port assemblies for theperformance of surgical procedures, particularly including laparoscopicprocedures, for instance, entirely through the umbilicus.

An object of the present invention is to provide an improved portassembly for facilitating access to internal organs of a patient duringlaparoscopic procedures.

Another object of the present invention is to provide such a portassembly that provides enlarged workspace for the hands of thesurgeon(s) when plural laparoscopic instruments are placed through theumbilicus.

These and other objects of the invention will be apparent from thedrawings and descriptions herein. Although each object of the inventionis believed to be attained by at least one embodiment of the invention,there is not necessarily any single embodiment that achieves all of theobjects of the invention.

SUMMARY OF THE INVENTION

The present invention facilitates the performance of laparoscopicsurgical procedures wherein several laparoscopic instruments areinserted into a patient through respective cannulas all extendingthrough the same opening in the patient, for instance, through theumbilicus. The advantages of such an operation include minimizing traumato the patient and accelerating the patient recovery.

A first embodiment of a surgical port assembly in accordance with thepresent invention comprises a body attachable to a patient at anincision in a skin surface of the patient to facilitate deployment ofinstruments in the patient via the incision. The body has a main axisoriented substantially transversely to the patient's skin surface upondisposition of the body in the incision. The port assembly furthercomprises a main first plate, a second plate, at least one first tubularmember and a second tubular member. The first plate has a first openingand a second opening and is mounted to the body substantiallytransversely to the axis. The second plate is rotatably disposed in thefirst opening for turning about an auxiliary axis preferablysubstantially parallel to the main axis. The first tubular member isattached to the second plate and extends in at least one direction awayfrom the second plate. The second tubular member is attached to thefirst plate at the second opening and extends in at least one directionaway from the first plate.

The body of the port assembly has an outer side facing away from thepatient and an inner side facing inwardly of or towards the patient'sskin surface during a surgical procedure. Pursuant to one alternativedesign of the port assembly, the first tubular member extends onlyupwardly or outwardly away from the second plate, on the outer side ofthe body. Preferably, the first tubular member is one of a plurality offirst tubular members all attached to the second plate and extendingonly upwardly or outwardly away from the second plate, on the outer sideof the body. According to a specific feature of this design, at leastone of the first tubular members is flexible at least at a point ofattachment to the second plate, enabling a pivoting (about a transverseaxis) and/or a swiveling (about a longitudinal axis) at the second plateof a surgical instrument inserted through the at least one of the firsttubular members. The first tubular members are each provided with atleast one seal for maintaining pneumoperitoneum when a surgicalinstrument shaft longitudinally traverses such first tubular member andat least one seal for maintaining pneumoperitoneum in the absence of asurgical instrument shaft longitudinally traversing such first tubularmember.

Pursuant to another alternative design of the port assembly, the firsttubular member extends only downwardly or inwardly away from the secondplate, on the inner side of the body. Preferably in this design, thefirst tubular member is one of a plurality of first tubular members allattached to the second plate and extending only downwardly or inwardlyaway from the second plate, on the inner side of the body. According toa specific feature of this alternative design, at least one of the firsttubular members is flexible at least at a point of attachment to thesecond plate, enabling a pivoting (about a transverse axis) and/or aswiveling (about a longitudinal axis) at the second plate of a surgicalinstrument inserted through the at least one of the first tubularmembers. Again, the first tubular members are each provided with atleast one seal for maintaining pneumoperitoneum when a surgicalinstrument shaft longitudinally traverses such first tubular member andat least one seal for maintaining pneumoperitoneum in the absence of asurgical instrument shaft longitudinally traversing such first tubularmember.

Pursuant to additional features of the present invention, the secondplate is dome-shaped and the second plate is removably attached to thefirst plate.

A second embodiment of a surgical port assembly in accordance with thepresent invention comprises a body attachable to a patient at anincision in a skin surface of the patient to facilitate deployment ofinstruments in the patient via the incision, the body having an outerside facing away from the patient and an inner side facing inwardly ofor towards the patient's skin surface during a surgical procedure. Atleast one tubular member depends downwardly or inwardly from the body sothat the tubular member is disposed only on the inner side of the body.

The downwardly depending tubular member is preferably one of a pluralityof tubular members all depending downwardly or inwardly from the body sothat the tubular members are disposed only on the inner side of thebody. Each of the tubular members is preferably provided with at leastone seal for maintaining pneumoperitoneum when a surgical instrumentshaft longitudinally traverses such tubular member and additionallyprovided with at least one seal for maintaining pneumoperitoneum in theabsence of a surgical instrument shaft longitudinally traversing suchtubular member.

The downwardly depending tubular members may be made fully or partiallyof elastomeric material. Preferably, the tubular members are tiltable atleast at an upper end

In accordance with a further feature of the present invention, thedownwardly depending tubular members are each provided along an innersurface with a rigid sleeve so arranged that the tubular members areeach pivotable about a point of attachment to the body.

The body of the port assembly may have a funnel shape. In that case, thetubular members are attached to the funnel shape at an apical endthereof. The funnel shape may be a truncated cone that may have acircular, elliptical, oval or other cross-section.

In this second embodiment of the present invention, the outer side ofthe port assembly's body is free of upwardly or outwardly extendingtubular cannula members and comprises a rim portion and a platesurrounded by the rim portion, the tubular members being connected tothe plate and extending only on an inner side of the plate. The rimportion may sit on the skin surface of the patient and be attachedthereto via adhesive. Alternatively, the rim portion may insert at leastpartially into the incision in the skin surface. In either case, the rimportion may have a circular or annular configuration.

The one or more downwardly depending tubular members may be detachablyattached to the port assembly's body. In that case, the tubular memberor members are fixed to a coupling member that in turn is detachablyattached to the body at an aperture in the body. The port assembly mayfurther comprise a plug to temporarily seal the aperture upon removal ofthe coupling member from the aperture.

Pursuant to another feature of the invention, the singular downwardlydepending tubular member or one of the multiple downwardly dependingtubular members carries a camera at a free end. The camera-carryingtubular member may be provided with directional cables that areactuatable from the outer or upper side of the port assembly forchanging an orientation of the free end of the respective tubular memberand the camera.

A third embodiment of a surgical port assembly comprise, in accordancewith the present invention, a body attachable to a patient at anincision in a skin surface of the patient to facilitate deployment ofinstruments in the patient via the incision, the body having an outerside facing away from the patient and an inner side facing inwardly ofor towards the patient's skin surface during a surgical procedure. Afunnel-shaped extension is provided on the outer side of the body. Thebody together with the funnel-shaped extension may be made of a rigidmetallic or polymeric material or a tough elastomeric material with someresilience and flexibility.

An obturator for deployment of a surgical port assembly (such as thesecond embodiment described above) through a skin surface comprises abody member, locking formations on the body member releasably engageablewith cooperating locking formations on the port assembly, at least twofinger contact surfaces on the body member, the finger contact surfacesfacing in substantially opposed directions, for enabling manualapplication of a torque to the body member, and at least one elongaterigid member extending away from the body member on a side thereofopposite the finger contact surfaces, for penetrating through a skinsurface.

The rigid member may be one of a plurality of parallel elongate rigidmembers extending away from the body member on a side thereof oppositethe finger contact surfaces, for penetrating through a skin surface. Themultiple rigid members of the obturator insert into respectivedownwardly depending tubular members of the second port assemblyembodiment described above. The rigid members of the obturator thusserve to stiffen and hold the tubular members when the port assembly isbeing deployed at the onset of a minimally invasive surgical procedure,for example, a laparoscopic or thoracoscopic operation.

Accordingly, it is contemplated that the obturator is a component of asurgical access assembly or kit that further comprises a surgical portassembly including (a) a port assembly body attachable to a patient atan incision in a skin surface of the patient to facilitate deployment ofinstruments in the patient via the incision, the body having an outerside facing away from the patient and an inner side facing inwardly ofor towards the patient's skin surface during a surgical procedure, and(b) a plurality of elastomeric tubular members all depending downwardlyor inwardly from the port assembly body so that the tubular members aredisposed only on the inner side of the body, the tubular membersreceiving respective ones of the elongate rigid members.

The locking formations may include projections on the body member or theobturator and recesses on the port assembly. The body member may takethe form of a disk, which is provided with at least one cutout forenabling passage of an insufflation tube.

A surgical port assembly in accordance with one embodiment of thepresent invention comprises a body member and a skirt member. The bodymember is attachable to a patient at an incision in a skin surface ofthe patient to facilitate deployment of instruments in the patient viathe incision, the body having an outer side facing away from the patientand an inner side facing inwardly of or towards the patient's skinsurface during a surgical procedure. The skirt member is at leastpartially flexible and is attached to the body on the inner sidethereof.

This embodiment of a surgical port assembly in accordance with thepresent invention may further comprise a trocar member insertablethrough the body and traversing the body during a deployment procedure.The skirt member has a collapsed or folded-in insertion configuration,wherein the skirt member is releasably attached to the trocar memberduring the deployment procedure. A portion of the skirt member may beremovably inserted into a slot in the trocar member, to hold the skirtmember in the folded-in configuration.

The skirt member may have a tapered expanded configuration wherein afree end of the skirt member, opposite the body member, has a largertransverse dimension that an end of the skirt attached to the bodymember.

The skirt member may include a flexible web member and a resilientsupport wire connected to the web member for expanding the web memberfrom a folded-in insertion configuration to an expanded useconfiguration.

The skirt member may include flexible strip areas interleaved oralternating with more rigid areas.

Pursuant to additional specific features of the present invention, thebody member may include a cylindrical portion, a dome on an upper orproximal side of the cylindrical portion, and a circumferential orannular disk-shaped flange, the dome being formed with a plurality ofopenings for passage of laparoscopic or thoracoscopic instrument shaftsand a laparoscope or endoscope. The skirt member includes a cylindricalsection engaging the cylindrical portion of the body and furtherincludes a tapered or conical portion.

A related surgical port element in accordance with the present inventioncomprises a skirt made at least partially of flexible material and meansfor attaching the skirt to a cannula or instrument holder in turnremovably attachable to a patient at an opening in a skin surface. Theskirt has a folded-in insertion configuration and an expanded useconfiguration.

A surgical port component comprises, in accordance with the presentinvention, a body including a cylindrical portion formed by a pluralityof cylindrical sections or flaps. The body further includes aring-shaped base member, the cylindrical sections or flaps beingswingably coupled to the base member. The cylindrical sections or flapsare made of at least a substantially rigid material, and the base memberis provided with at least one upwardly or proximally extending arcuateflange section receivable into a distal or lower end of a cylindricalbody of a flexible-cannula port member. An at least partially flexibleskirt may be coupled to the body of the port component, for instance, bya cylindrical proximal sleeve section of the skirt fitting over thecylindrical sections or flaps.

Another surgical port assembly in accordance with the present inventioncomprises a body member and a flexible scope arm. The body member isattachable to a patient at an incision in a skin surface of the patientto facilitate deployment of instruments in the patient via the incision,the body member having an outer side facing away from the patient and aninner side facing inwardly of or towards the patient's skin surfaceduring a surgical procedure. The flexible scope arm is connected to thebody member and extends from an underside of the body member. The scopearm incorporates a digital camera at a distal end, the camera beingmaneuverable via cables in the scope arm, the scope arm beingoperatively connectable at a proximal end to an endoscope functionalmodule enabling operation of the camera.

A thoracoscopic surgical port assembly in accordance with the presentinvention comprises (a) a downwardly tapering, substantially flexible,upper or proximal part, and (b) an upwardly tapering, substantiallyflexible lower or distal part connected to the upper or proximal part.The lower or distal part is extendable in between the ribs of a patientinto a pleural space. A substantially rigid ring-like structure isdisposed proximate a junction between the upper or proximal part and thelower or distal part. The ring structure is locatable, during use of theport assembly, on top of a patient's ribs. A flexible membrane isprovided proximate the ring structure, the membrane having a pluralityof openings for passage of the instruments.

A surgical port assembly comprises, in accordance with anotherembodiment of the present invention, a rigid mounting ring, a bodymember and a cannula unit. The ring is disposable on and releasablyattachable a patient's skin surface. The body member is attachable tothe ring to depend downwardly therefrom through an incision in thepatient's skin surface to facilitate deployment of instruments in thepatient via the incision. The body member has an outer side facing awayfrom the patient and an inner side facing inwardly of or towards thepatient's skin surface during a surgical procedure. The body member isrotatably attachable to the ring for turning about an axis orientedperpendicularly to a plane defined by the ring. The cannula unit isattachable to the body member and carries a plurality of cannulas.

Yet another surgical port assembly in accordance with the presentinvention comprises a body attachable to a patient at an incision in askin surface of the patient to facilitate deployment of instruments inthe patient via the incision, the body having an outer side facing awayfrom the patient and an inner side facing inwardly of or towards thepatient's skin surface during a surgical procedure. The port assemblyalso comprises a cannula unit including an elastomeric dome-shaped baseand a plurality of upwardly extending tubular members or cannulas eachprovided with a cap housing a plurality of seals.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is partially a schematic side elevational view and partially aschematic longitudinal cross-sectional view of a trocar or surgical portassembly in accordance with the present invention, showing a skirtfolded into an obturator for deployment.

FIG. 2 is a schematic cross-sectional view of the trocar or portassembly of FIG. 1, showing the skirt in a free depending configuration.

FIG. 3 is a schematic cross-sectional view of the trocar or portassembly of FIGS. 1 and 2, showing a dome with finger or seal membersattached to a body member in the port assembly.

FIG. 4 is a schematic longitudinal cross sectional view of anothertrocar or surgical port assembly in accordance with the presentinvention, showing a trocar body with an apertured plate therein.

FIG. 5 is a top plan view of the plate of FIG. 4, showing a pair ofopenings.

FIG. 6 is a schematic longitudinal cross-sectional view of a modifiedtrocar or surgical port assembly in accordance with the presentinvention, showing a trocar body with a perforated plate therein.

FIG. 7 is a top plan view of the trocar or surgical port assembly ofFIG. 6, showing three instrument ports.

FIG. 8 is a partial schematic cross-sectional view, on a larger scale,of the modified trocar or surgical port assembly of FIGS. 6 and 7.

FIG. 9 is a partial cross-sectional view taken along line IX-IX in FIG.6.

FIG. 10 is a schematic longitudinal cross-sectional view of anothermodified trocar or surgical port assembly in accordance with the presentinvention, largely similar to the port assembly of FIGS. 6-8.

FIG. 11 is a top plan view of the trocar or surgical port assembly ofFIG. 10, showing three instrument ports.

FIG. 12 is a partial schematic cross-sectional view, on a larger scale,of the modified trocar or surgical port assembly of FIGS. 10 and 11.

FIG. 13 is a schematic longitudinal cross-sectional view of anothertrocar or surgical port assembly in accordance with the presentinvention.

FIG. 14 is a cross-sectional view taken along line XIV-XIV in FIG. 13.

FIG. 15 is a schematic longitudinal cross-sectional view of a furthertrocar or surgical port assembly in accordance with the presentinvention.

FIG. 16 is a top plan view of the trocar or surgical port assembly ofFIG. 15, showing three instrument ports and an insufflation port. Thecross-sectional view of FIG. 15 is taken along line XV-XV in FIG. 16.

FIG. 17 is a partial cross-sectional view, on a larger scale, of adetail XVII of FIG. 15.

FIG. 18 is a schematic longitudinal cross-sectional view of the trocaror surgical port assembly of FIGS. 15-17, showing the port assemblyrotatably supported via a mounting ring on a patient's abdomen.

FIG. 19 is a top plan view of the trocar or surgical port assembly andmounting ring of FIG. 16. The cross-sectional view of FIG. 18 is takenalong line XVIII-XVIII in FIG. 19.

FIG. 20 is a schematic longitudinal cross-sectional view of a furthertrocar or surgical port assembly in accordance with the presentinvention, showing the port assembly deployed in an abdominal wall of apatient.

FIG. 21 is a top plan view of the trocar or surgical port assembly ofFIG. 20, showing three instrument ports. The cross-sectional view ofFIG. 20 is taken along line XX-XX in FIG. 21.

FIG. 22 is a schematic side elevational view, partially incross-section, of a further trocar or surgical port assembly inaccordance with the present invention, showing a skirt in a collapsedinsertion configuration.

FIG. 23 is partially a side elevational view similar to FIG. 22, showingthe skirt in an expanded use configuration.

FIG. 24 is a schematic perspective top view of another surgical portassembly in accordance with the present invention.

FIG. 25 is a schematic perspective bottom view of the surgical portassembly of FIG. 24.

FIG. 26 is a schematic top perspective view of an expandable skirtutilizable in a surgical port assembly in accordance with the presentinvention.

FIG. 27 is a side elevational view of the skirt of FIG. 26.

FIG. 28 is a top view of the skirt of FIGS. 26 and 27.

FIG. 29 is a schematic top perspective view of an elastomeric two-shotdomed trocar or port assembly in accordance with the present invention.

FIG. 30 is a side elevational view of the port assembly of FIG. 29.

FIG. 31 is a top plan view of the port assembly of FIGS. 29 and 30.

FIG. 32 is a longitudinal cross-sectional view taken along lineXXXII-XXXII in FIG. 31.

FIG. 33 is a schematic top perspective view of a body member of a hingedtrocar or port assembly in accordance with the present invention.

FIG. 34 is a longitudinal cross-sectional view of the port assembly bodymember of FIG. 33, showing the body member together with a skirt.

FIG. 35 is a top plan view of the port assembly of FIG. 33. Thelongitudinal cross-sectional view of FIG. 34 is taken along lineXXXIV-XXXIV in FIG. 35.

FIG. 36 is a perspective view of the port assembly of FIGS. 34 and 35.

FIG. 37 is a schematic top perspective view of yet another trocar orport assembly in accordance with the present invention.

FIG. 38 is a longitudinal cross-sectional view of the port assembly bodymember of FIG. 37.

FIG. 39 is a side elevational view of the port assembly of FIGS. 37 and38.

FIG. 40 is a perspective view of a lower portion of the port assembly ofFIGS. 37-39, showing multiple insufflation port elements.

FIG. 41 is a schematic top perspective view of another trocar or portassembly in accordance with the present invention, similar to the trocaror port assembly of FIGS. 37-39.

FIG. 42 is a longitudinal cross-sectional view of the port assembly ofFIG. 41.

FIG. 43 is a side elevational view of the port assembly of FIGS. 41 and42.

FIG. 44 is a perspective view of a lower portion of the port assembly ofFIGS. 40-43, showing multiple insufflation port elements.

FIG. 45 is a schematic top perspective view of a three-fingeredobturator, in accordance with the present invention, exemplarily for usein deploying the trocar or port assembly of FIGS. 37-40 or FIGS. 41-44in a patient at the onset of a minimally invasive laparoscopic orthoracoscopic surgical procedure.

FIG. 46 is a side elevational view of the obturator of FIG. 45.

FIG. 47 is a top plan view of the obturator of FIGS. 45 and 46.

FIG. 48 is a schematic top perspective view of another trocar or portassembly in accordance with the present invention.

FIG. 49 is a longitudinal cross-sectional view of the port assembly ofFIG. 48.

FIG. 50 is a side elevational view of the port assembly of FIGS. 48 and49.

FIG. 51 is a perspective view of a lower portion of the port assembly ofFIGS. 40-43, showing multiple insufflation port elements.

FIG. 52 is a schematic perspective view, partially cut away, of yetanother trocar or port assembly in accordance with the presentinvention.

FIG. 53 is a schematic perspective view of a laparoscopic instrument foruse with a surgical port assembly in accordance with the presentinvention.

FIG. 54 is a schematic perspective view of a surgical port assembly withan integrated endoscope shaft or arm, in accordance with the presentinvention.

FIG. 55 is a schematic perspective view, similar to FIG. 54 but on alarger scale, showing a functional housing component on a proximal endof the endoscope shaft or arm of FIG. 54.

FIG. 56 is a schematic cross-sectional view of a thoracic surgical portin accordance with the present invention, taken along a wide dimensionof the port, line LVI-LVI in FIG. 57.

FIG. 57 is a schematic cross-sectional view of a thoracic surgical port,taken along a narrow dimension of the port, line LVII-LVII in FIG. 58.

FIG. 58 is a schematic perspective view of the thoracic surgical port ofFIGS. 56 and 57.

FIG. 59 is a broken-away schematic perspective view, on a larger scale,of the thoracic surgical port of FIGS. 56-58.

DETAILED DESCRIPTION

As depicted in FIG. 1, a trocar or surgical port assembly 10 useful forlaparoscopic or thoracoscopic surgery includes a rigid annular trocarbody 12 having a cylindrical portion 14 and a circular flange 16 at aproximal or outer end of the cylindrical portion. Surgical port assembly10 further includes a fabric or elastomeric skirt 18 attached to adistal end of cylindrical portion 14. An obturator 20 includes a knob orhandle 22 and a rigid insertion portion 24 slidably insertable throughcylindrical portion 14 of trocar body 12. Rigid insertion portion 24 isprovided with a longitudinal slot 26 into which a portion 28 of skirt 18is folded and secured for facilitating deployment of the port assemblyat the onset of a minimally invasive surgical procedure. After insertionof the assembly into an incision, obturator 20 is removed, freeing theskirt, as shown in FIG. 2. Subsequently, a pneumoperitoneum maintenancecomponent 30 (FIG. 3) is attached to trocar body 12 for enabling thepassage of instrument shafts through port assembly 10 and into apatient. Cylindrical portion 14 of trocar body 12 is formed internallywith an annular rib or a plurality of inwardly extending nubs 29defining a shoulder on which obturator 20 and component 30 alternativelyrest.

Component 30 comprises an elastomeric dome-shaped base 32 and aplurality of upwardly extending tubular members or cannulas 34-36 eachprovided with a cap 38 housing a plurality of seals (not shown). Theseseals include a valve (e.g., a tricuspid valve) to prevent air leakagewhen no instrument is inserted through the tubular member or cannula34-36. The seals further include an instrument seal exemplarily in theform of a resilient ring or bead fixed to the internal wall of thecannula 34-36 or respective cap 38. Upon insertion of an instrumentshaft through a cannula 34-36, the ring or bead hugs the instrument andprevents or minimizes the leakage of insufflation gas. Additional ringor other seals may be incorporated, particularly where the ring or beadseals are provided along a flexible portion of a tubular port member orcannula 34-36. The multiple seals prevent loss of pneumoperitoneumthrough a cannula 34-36 when an instrument extending therethrough isbeing manipulated during a procedure.

Generally, in a laparoscopic operation, one of the fingers or cannulas34-36 receives a laparoscope, while laparoscopic instrument shaftstraverse the other two. All three cannulas 34-36 extend away from trocarbody 12 only on an outer or upper side thereof, facing away from apatient during a surgical procedure. The underside of the trocar body 12is free of cannulas. One of the fingers or cannulas 36 is provided witha luer fitting 40 for enabling insufflation of a patient's abdominalcavity during laparoscopic surgery. The fitting is not needed in manythoracoscopic procedures.

Dome-shaped base 32 is provided along a lower periphery with a sealingring 42 that engages rib or shoulder 29 on cylindrical portion 14.Sealing ring 42 has a sliding engagement with an inner surface (notlabels) of cylindrical portion 14 to facilitate a rotation of component30 about an axis 46 of body member 12. Along an outer surface (notdesignated), cylindrical portion 14 is formed with a plurality ofoutwardly extending circumferential ribs or beads 44 for inhibitingslippage in an incision.

As depicted in FIGS. 4 and 5, a surgical port assembly 50 comprises anannular body 52 attachable to a patient at an incision in a skin surfaceof the patient to facilitate deployment of instruments in the patientvia the incision. More particularly, annular body 52 includes acylindrical insert portion 54 and a flange 56 surrounding a proximal(closer to the surgeon) or outer end of the cylindrical insert portion.Insertion portion 54 is provided along an outer surface with a pluralityof longitudinally spaced circular beads 58 and along an inner surfacewith a circular shoulder 60 (or at least three inwardly extending nubsdefining a ledge). Shoulder 60 supports a rigid plate 62 formed with aninstrument opening 64 and a scope opening 66. Plate 62 may be rotatablyor rigidly secured to cylindrical insert portion 54 of annular body 52.An ancillary second plate 68 having a dome shape is rotatably andremovably attached to the main plate 62 over opening 64. Ancillary plate68 carries a pair of integrally formed tubular members or cannulas 70made of a flexible material and provided at free ends with respectivesealing caps 72. A third tubular sealing member or cannula 74 isattached to main plate 62 over scope opening 66 for enabling theintroduction of a distal end portion of a laparoscope or other endoscopeinto a patient through port assembly 50. Scope cannula 74 has a luerfitting 76 for insufflation purposes. Tubular fingers or cannulas 70 and74 extend in an upper direction away from plates 62 and 68 and aredisposed only on an upper or outer side thereof, facing away from apatient during a surgical procedure. The lower or inwardly facing sideof port assembly 50 is free of cannula parts.

Plate 68 is rotatably disposed in or at opening 64 for turning about anaxis 78 preferably substantially parallel to a main axis 79 of portassembly 50.

Tubular fingers or cannulas 70 and 74 are flexible at least at a pointof attachment to plates 68 and 62, respectively, enabling a pivoting(about a transverse axis) and/or a swiveling (about a longitudinal axis)of surgical instruments (or an endoscope) inserted through the tubularfingers or cannulas 70, 74. Fingers or cannulas 70, 74 are each providedwith at least one seal for maintaining pneumoperitoneum when a surgicalinstrument shaft longitudinally traverses such finger or cannula and atleast one seal for maintaining pneumoperitoneum in the absence of asurgical instrument shaft longitudinally traversing such finger orcannula.

FIGS. 6-8 illustrate a modified version 80 of the trocar or surgicalport assembly of FIGS. 4 and 5. Surgical port assembly 80 comprises anannular body 82 attachable to a patient at an incision in a skin surfaceof the patient to facilitate deployment of instruments in the patientvia the incision. More particularly, annular body 82 includes acylindrical insert portion 84 and a flange 86 surrounding a proximal orouter end of the cylindrical insert portion. Insertion portion 84 isprovided at a distal or inner end with an annular slot 88 that receivesen edge of a skirt 90. Skirt 90 is an elastomeric annular or slotted webmember in which a plurality of longitudinal support wires 92 areembedded (see FIG. 9). At least some of the wires 92 extend generallyparallel to a longitudinal axis 94 of trocar body 82. Wires 92 serve toform skirt 90 into an expanded funnel shape upon deployment of thesurgical port assembly 80 in a patient.

Trocar body 82 is formed along an inner surface with a ledge or plate 96defining an instrument opening 98 and a scope opening 100. Plate 96 isrigidly secured to cylindrical insert portion 84 of annular body 82. Anancillary second plate or disk 102 is rotatably and removably attachedto the main plate 96 over opening 98. A locking ring 104 may be provided(FIG. 8) for releasably holding plate or disk 102 to plate 96 at opening98. Ancillary plate or disk 102 carries a pair of tubular fingers orcannulas 106 made of a flexible material and provided at free ends withrespective sealing caps 108. Fingers or cannulas 106 may be removablyattached to plate or disk 102. To that end, plate or disk 102 may beformed with a pair of outwardly extending sleeves 110 (FIG. 8)insertable into tubular fingers or cannulas 106. A third tubular sealingfinger or cannula 112 is attached to main plate 96 over scope opening100 for enabling the introduction of a distal end portion of alaparoscope or other endoscope into a patient through port assembly 80.Scope cannula 112 may have a luer fitting (not shown) for insufflationpurposes. Tubular fingers or cannulas 106 and 112 extend in an upperdirection away from plates 96 and 102 and are disposed only on an upperor outer side thereof, facing away from a patient during a surgicalprocedure. The lower or inwardly facing side of port assembly 80 is freeof cannula parts.

Plate or disk 102 serves as a cannula carrier that is rotatably disposedin or at opening 98 for turning about an axis 114 preferablysubstantially parallel to main axis 94 of port assembly 80.

Tubular fingers or cannulas 106 and 112 are flexible at least at a pointof attachment to plates 102 and 96, respectively, enabling a pivoting(about a transverse axis) and/or a swiveling (about a longitudinal axis)of surgical instruments (or an endoscope) inserted through the portsformed by tubular fingers or cannulas 106, 112. Fingers or cannulas 106,112 are each provided with at least one seal for maintainingpneumoperitoneum when a surgical instrument shaft longitudinallytraverses such finger or cannula and at least one seal for maintainingpneumoperitoneum in the absence of a surgical instrument shaftlongitudinally traversing such finger or cannula.

FIG. 6 shows an obturator shaft 118 and skirt 90 folded and tucked intoa slot along shaft 118. A knob (not shown) at the proximal or outer endof obturator shaft 118 is pushed to release skirt 90 from obturatorshaft 118. The obturator is then pulled out and discarded. A release anddiscard safety tab is shown at 120.

FIGS. 10-12 depict a port assembly 80′ that is a modified version ofport assembly 80 of FIGS. 6-8. The same reference numerals are used inFIGS. 10-12 to designate the same parts as shown in FIGS. 6-8. Insteadof integral or unitary main plate 96, port assembly 80′ has a removablemain plate 122 that is releasably secured to cylindrical insertionportion 84 via a plurality of spring-loaded detents 124. Main plate 122sits on an inwardly extending shoulder 126 (or series of nubs) and isheld thereto in a snap lock fit by the plurality of spring-loadeddetents 124.

As shown in FIGS. 13 and 14, another trocar or surgical port assembly130 comprises an annular body 132 attachable to a patient at an incisionin a skin surface of the patient to facilitate deployment of instrumentsin the patient via the incision. Annular body 132 includes asubstantially oval insert portion 134 and a flange 136 at a proximal(closer to the surgeon) or outer end of the cylindrical insert portion.Insertion portion 134 is provided along an outer surface with aplurality of longitudinally spaced circular beads 138 and along an innersurface with a substantially annular or endless groove 140. A skirt (notshown) may be attached to an inner or distal end 142 of cylindricalinsert portion 134.

Groove 140 receives an outer end of a rigid support or base plate 144provided with three slots 146-148. Central slot 147 is intended forinsertion of a laparoscope in an abdominal operation, while lateralslots 146 and 148 are intended for the passage of instrument shafts. Anancillary second plate 150 made of elastomeric material having a domeshape is attached to the support or base plate 144 over opening slots146-148. Base plate 144 and ancillary plate 150 have a generallyelongate or oval cross-section, as seen in FIG. 14. Ancillary plate 150carries three integrally formed tubular members or cannulas 152 (oneprovided with a luer fitting 154 for insufflation) made of flexibleelastomeric material and provided at free ends with respective sealingcaps 156. Tubular fingers or cannulas 152 extend in an upper directionaway from plates 144 and 150 and are disposed only on an upper or outerside thereof, facing away from a patient during a surgical procedure.The lower or inwardly facing side of port assembly 130 is free ofcannula parts.

Tubular fingers or cannulas 152 are flexible at least at a point ofattachment to plate 150, enabling a pivoting (about a transverse axis)and/or a swiveling (about a longitudinal axis) of surgical instruments(or an endoscope) inserted through the tubular fingers or cannulas.Fingers or cannulas 152 are each provided (for instance, in caps 156)with at least one seal for maintaining pneumoperitoneum when a surgicalinstrument shaft longitudinally traverses such finger or cannula and atleast one seal for maintaining pneumoperitoneum in the absence of asurgical instrument shaft longitudinally traversing such finger orcannula.

As shown in FIGS. 15-17, a further trocar or surgical port assembly 160comprises an annular body 162 attachable to a patient at an incision ina skin surface of the patient to facilitate deployment of instruments inthe patient via the incision. Annular body 162 includes a cylindricalinsert portion 164 and a flange 166 at a proximal or outer end of thecylindrical insert portion. A skirt (not shown) may be attached to aninner or distal end 168 of cylindrical insert portion 164.

A groove 170 provided in a widened section 172 of cylindrical insertionportion 164 permanently receives an outer periphery of a perforatedsupport or base plate 174. Plate 174 may be made of a rigid (e.g.metallic) or elastomeric material and is formed with three instrumentopenings 176 and a smaller insufflation opening 178. Three elastomerictubular fingers or cannulas 180 are connected to plate 174 andcommunicate with respective openings 176. In the case of an elastomericbase plate 174, cannulas 180 are formed integrally therewith. Tubularfingers or cannulas 180 are flexible at least at a point of attachmentto plate 174, enabling a pivoting and/or swiveling of surgicalinstruments (or an endoscope) inserted through the tubular fingers orcannulas. Fingers or cannulas 152 are each provided with at least oneinner ring seal 182 for maintaining pneumoperitoneum when a surgicalinstrument shaft longitudinally traverses such finger or cannula and atleast one seal (e.g., a tricuspid valve at a lower end 184) formaintaining pneumoperitoneum in the absence of a surgical instrumentshaft longitudinally traversing such finger or cannula.

Tubular fingers or cannulas 180 serve to seal the abdominal cavityduring pneumoperitoneum and further serve to protect the patient'sinternal tissues, such as the abdominal wall tissues. Fingers orcannulas 180 extend only downwardly or inwardly away from support orbase plate 174, on the inner side of the trocar body 162.

FIGS. 18 and 19 show a scheme for deploying the port assembly 160 ofFIGS. 15-17. A rigid mounting ring 186 is disposed on a skin surface SSover a patient's abdominal cavity AC and attached to the skin viasutures 188 and 190. Sutures 188 and 190 are sewn at one end 192 to thepatient and are tied at opposing ends to respective dual-hook members194 that are upwardly inclined from mounting ring 186. An outerperiphery (not labeled) of flange 166 is slidably inserted into anannular groove 196 provided on an inner surface of mounting ring 186.Cylindrical portion 164 of port assembly body 162 depends downwardlyinto the abdominal wall AW of a patient during a surgical procedure.Fingers or cannulas 180 extend through a portion of abdominal wall AWand into an abdominal cavity AC of the patient. Trocar body 162 may beturned about a longitudinal axis 198 of port assembly 160, whilemounting ring 186 remains stationary relative to the patient, tofacilitate the manipulation of laparoscopic instruments (not shown)whose shafts are inserted through respective fingers or cannulas 180.

FIGS. 20 and 21 depict an alternative surgical access port assembly 200comprising an annular body 202 attachable to a patient at an incisionNCSN in a skin surface SS of the patient to facilitate deployment ofinstruments in the patient via the incision. Annular body 202 includes amounting ring 204 fixed to an adhesive pad 206 that in turn isreleasably adhered to skin surface SS about incision NCSN. Port assembly200 further comprises a rigid plate 208 rotatably or rigidly secured tomounting ring 204 via a locking ring 210. Plate 208 may be made of arigid (e.g. metallic) or elastomeric material and is formed with threeinstrument openings 212 and a smaller insufflation opening (not shown).Three elastomeric tubular fingers or cannulas 214 are connected to plate208 and communicate with respective openings 212. In the case of anelastomeric base plate 208, cannulas 214 are formed integrallytherewith. Tubular fingers or cannulas 214 are flexible at least at apoint of attachment to plate 208, enabling a pivoting and/or swivelingof surgical instruments (or a scope) inserted through the tubularfingers or cannulas. Fingers or cannulas 214 are each provided with atleast one inner ring seal (not sown) for maintaining pneumoperitoneumwhen a surgical instrument shaft longitudinally traverses such finger orcannula and at least one seal (e.g., a tricuspid valve at a lower end216) for maintaining pneumoperitoneum in the absence of a surgicalinstrument shaft longitudinally traversing such finger or cannula.

Tubular fingers or cannulas 214 serve to seal the abdominal cavity ACduring pneumoperitoneum in a laparoscopic procedure and further serve toprotect the patient's internal tissues, such as the tissues of abdominalwall AW. Fingers or cannulas 214 extend only downwardly or inwardly awayfrom support or base plate 208, on the inner side of the body 202.Fingers or cannulas 214 can accommodate instrument shafts that are fullyflexible as well as instruments shaft that have preformed rigid shapes,including C-shaped and S-shaped portions.

As illustrated in FIGS. 22 and 23, another trocar or surgical portassembly 220 comprises an annular body 222 attachable to a patient at anincision in a skin surface of the patient to facilitate deployment ofinstruments in the patient via the incision. Annular body 222 includes acylindrical insert portion 224 and a flange 226 at a proximal or outerend of the cylindrical insert portion. A skirt 228 is attached to aninner or distal end 230 of cylindrical insert portion 224. Skirt 228includes a flexible web 232 and a stent wire 234 attached to the web(e.g., inserted into a cavity or pocket, not shown, formed in the web).Wire 234 has a zig-zag or snaking configuration and serves tospring-bias web 232 into a conical or funnel-shaped open configurationshown in FIG. 23. Trocar or surgical port assembly 220 additionallycomprises a purse-string closure element 236 disposed about a distal orfree end of skirt 228 for the skirt in a closed or pointed insertionconfiguration (FIG. 22) in opposition to the opening force exerted bywire 234. Purse string closure element 236 is connected to a deploymentknob or button 237 via an obturator shaft 238. Upon insertion of foldedor pointed skirt 228 (FIG. 22) and cylindrical insert portion 224 intoan abdominal wall of a patient, the user actuates knob or button 237 torelease purse-string closure element 236, thereby enabling the openingof skirt 228 into the opened funnel-shaped use configuration (FIG. 23)under the biasing force exerted by wire 234.

Trocar or surgical port assembly 220 of FIGS. 22 and 23 comprisesadditional structure described hereinabove with reference to FIGS.10-12. The same reference numerals are used in FIGS. 10-12 and 22, 23 todesignate identical structures. In FIGS. 22 and 23, fingers or cannulas106 and 112 are additionally shown with sealing structures 239.

As shown in FIGS. 24 and 25, another trocar port assembly 240 comprisesa body member (not separately designated) including a funnel-shapedupper or proximal portion 242 and a cylindrical lower or distal portion244. Upper or proximal portion 242 is provided along a conical outersurface (not separately labeled) with a plurality of laterally groovedcylindrical posts 246 for receiving tie-down sutures (not shown) toanchor the trocar port assembly 240 to a patient at an incision site(such as the umbilicus). Cylindrical portion 244 is provided along anouter surface with a plurality of annular ribs 247 for enhancing aseating of the cylindrical portion in an incision. On an inner surfaceand at a bottom or distal end, cylindrical portion 244 is provided witha pair of opposing generally arcuate teeth or prongs 248 that serve tohold or lock a laparoscope or other endoscope in a position at theoutlet end of cylindrical portion 244. During a surgical procedure,laparoscopic instrument shafts (not shown) longitudinally traverseflexible fingers or cannulas (not shown) that pass through an open area249 in the bottom or distal end of cylindrical portion 244.

FIGS. 26-28 illustrate a trocar skirt 250 comprising a rigid supportring 252, a multiplicity of substantially rigid strips or bands 254connecting to one another via elastomeric sections 256. Rigid strips 254are arranged in an annular configuration and are concave in a radiallyoutward direction. Elastomeric sections 256 may be angularly orcircumferentially spaced portions of a single web or separate strips.Rigid strips or bands 254 are pivotably attached at an upper or proximalend to a mounting ring 258 in turn fastened to support ring 252. Thepivotable attachment of strips or bands 254 to mounting ring 258 maytake the form of a so-called living hinge, for example, wherein mountingring 258 and strips or bands 254 are integrally made of a substantiallyrigid polymeric material that is sufficiently thin at connecting pointsto enable a pivoting and/or swiveling motion.

Elastomeric sections 256 of trocar skirt 250 are capable of stretchingsufficiently to permit a full range of instrument and scope motionduring a surgical procedure while protecting a patient's abdominaltissues. Trocar skirt 250 has a corset shape, with a waist diameter thatmay alternately increase and decrease during instrument manipulation.

Trocar skirt 250 is attached to an underside of a trocar assembly suchas the port assemblies described hereinabove with reference to FIGS.1-14.

As shown in FIGS. 29-32, a trocar or surgical port assembly 260comprises an upper or proximal body 262 and a skirt 264. Body 262 ismade of a flexible elastomeric material and includes a cylindricalportion 266, a dome 268 and a circumferential or annular disk-shapedflange 270. Dome 268 is formed with a plurality of openings 272 for thepassage of laparoscopic or thoracoscopic instrument shafts (not shown)and a laparoscope or endoscope (not shown). Openings 272 are formed withslit-type seals for preventing the loss of pneumoperitoneum both wheninstruments shafts pass through the openings and when there are noinstruments traversing the openings. Dome 268 is further formed with atubular stub 274 that receives a distal end of an insufflation tube 276.Skirt 264 includes a cylindrical proximal sleeve 277 that fits over andis functionally connected to cylindrical portion 266. Skirt 264 furtherincludes a resilient frusto-conical portion 278 that is folded andpreferably held to an obturator shaft during insertion through anincision.

FIGS. 33-36 depict a trocar or surgical port assembly 280 including abody 282 having a cylindrical portion (not separately designated) formedby a plurality of cylindrical sections or flaps 284 swingably connectedto a ring-shaped base member 285 in the nature of a flange to thecylindrical portion. Flaps 284 are made of at least a substantiallyrigid material and each include plural longitudinally spaced arcuateribs 286 along a respective outer surface. Flaps 284 each have a hingeprojection 288 that is inserted through a slot 290 in base member 285.Projections 288 are hooked, to prevent a disassociation of flaps 284from base member 285. Base member 285 is provided with a plurality ofupwardly or proximally extending arcuate flange sections 292 that arereceived into a distal or lower end of a cylindrical body of aflexible-cannula port member such as the domed members of FIGS. 3 and13, 14.

Surgical port assembly 280 further comprises a skirt 294 including acylindrical proximal sleeve 296 that fits over flaps 284 and is therebyfunctionally connected to body 282. Skirt 294 further includes aresilient frusto-conical portion 298 that is folded and preferably heldto an obturator shaft during insertion through an incision.

As shown in FIGS. 37-39, yet another trocar port assembly 300 comprisesa body member (not separately designated) including a funnel-shapedupper or proximal portion 302 and a cylindrical lower or distal portion304. Upper or proximal portion 302 is provided along a circular rim 306with a plurality of suture anchors 308 in the form of substantiallyflat, generally triangular upwardly inclined posts for receivingtie-down sutures (not shown) to anchor the trocar port assembly 300 to apatient at an incision site (such as the umbilicus). Upper or proximalportion 302 is additionally provided along circular rim 306 with aplurality of rectangular recesses 310 for receiving mating projectionson an obturator (see FIGS. 45-47). Cylindrical portion 304 is providedalong an outer surface with a helical thread or one or more outwardlyextending ribs 312 for enhancing a sealed seating of the cylindricalportion in an incision.

Port assembly 300 further includes, at a bottom or distal end (notseparately enumerated) of cylindrical portion 304, an elastomeric“pants” member 314 illustrated separately in FIG. 40. Pants member 314includes a cannula carrier 316 and cannula members in the form of threeelastomeric legs or downwardly depending fingers 318, 319, 320 that areeach provided with an inwardly extending ring seal 322 and a tricuspidseal 324. Leg 320 is dedicated to the passage of a scope (not shown),while the remaining two legs 318, 319 have a wider and deeper entrancespace or antechamber 326 allowing an increased range of instrumentmotion and an easier crossing of the instrument shafts (not shown).

Legs or fingers 318-320 are provided internally withpolytetrafluorethylene stiffening tubes 328 that provide strength andrigidity and reduce friction. Stiffening tubes 328 facilitate thewithdrawal of laparoscopic instrument shafts (including scopes) bypreventing the entrainment of the instrument shafts to the legs orfingers 318-320. Accordingly, stiffening tubes 328 prevent a turninginside-out of legs or fingers 318-320.

Legs, fingers or cannulas 318-320 are flexible in a region of attachmentto domed cannula carrier 316, whereby the legs/fingers/cannulas may betemporarily bent into a parallel configuration for insertion into apatient through an incision with the aid of an obturator (see FIGS.45-47).

As shown in FIG. 40, cannula carrier 316 of pants member 314 includesmultiple insufflation ports 330 and 332 providing an option ofconnecting insufflation hoses (not shown) at a center (330) or aperiphery (332).

As depicted in FIGS. 41-44, a similar trocar port assembly 340 comprisesa body member 341 including a rigid conical upper or proximal portion342 and a cylindrical lower or distal portion 344. Upper or proximalportion 342 is provided along a circular rim 346 with a plurality ofsuture anchors 348 in the form of substantially flat, generallytriangular upwardly inclined posts for receiving tie-down sutures (notshown) to anchor the trocar port assembly 340 to a patient at anincision site (such as the umbilicus). Upper or proximal portion 342 isadditionally provided along circular rim 346 with a plurality ofrectangular recesses 350 for receiving mating projections on anobturator (see FIGS. 45-47). Cylindrical portion 344 is provided alongan outer surface with a helical thread or one or more outwardlyextending ribs 352 for enhancing a sealed seating of the cylindricalportion in an incision.

Port assembly 340 further includes, at a bottom or distal end (notseparately enumerated) of cylindrical portion 344, an elastomeric“pants” member 354 illustrated separately in FIG. 44. Pants member 354includes a domed cannula carrier 356 and cannula members in the form ofthree elastomeric legs or downwardly depending fingers 358, 359, 360that are each provided with (i) a ring seal 322 in the form of anannular bead and (ii) a tricuspid insufflation seal 324. Legs 358-360are identical and interchangeably used for the passage of a scope (notshown) or surgical instrument shafts (not shown). Legs 358-360 arecircumferentially equispaced and outwardly inclined in a mutually flaredconfiguration.

Legs or fingers 358-360 are lined with polytetrafluorethylene stiffeningtubes 362 that strengthen and rigidify the major portions of the legsand additionally reduce friction between the instrument shafts and thelegs. During the withdrawal of laparoscopic instrument shafts (includingscopes) from legs or fingers 358-360, stiffening tubes 362 prevent theentrainment of the instrument shafts to the legs or fingers. Thus,stiffening tubes 362 prevent legs or fingers 358-360 from turning insideout.

Legs, fingers or cannulas 358-360 are flexible in a region of attachmentto domed cannula carrier 356, thereby enabling a temporary deformationof the cannulas into a parallel configuration for insertion into apatient through an incision with the aid of an obturator (see FIGS.45-47). Legs, fingers or cannulas 358-360 are provided at an upper orproximal end with circumferential rind seals 361 and at a lower ordistal end 363 with tricuspid seals.

As depicted in FIG. 44, cannula carrier 356 of pants member 354 mayinclude a central insufflation port 364 with an outlet (not shown) on anouter or distal surface (not separately designated) of domed cannulacarrier 356. Alternatively or additionally, as depicted in FIGS. 41 and43, an insufflation tube 366 with a luer lock 368 may extend throughdomed carrier 356 and alongside a leg 360, as indicated at 369.

FIGS. 45-47 illustrate an obturator 370 for deployment of a surgicalport assembly such as assembly 300 or 340 through a skin surface of apatient. Obturator 370 comprises a disk-shaped body member 372, lockingformations 374 in the form of generally rectangular keys projectingradially outwardly from body member 372 and releasably engageable withcooperating locking formations on port assembly 300 or 340, namelyrectangular recesses 310 or 350. At least two finger contact surfaces376 and 378 are provided on body member 372, the finger contact surfacesfacing in substantially opposed directions, for enabling manualapplication of a torque to the body member. In the illustratedembodiment, finger contact surfaces 376 and 378 are formed on respectiveupstanding tabs (not separately designated) disposed along a diameter ofbody member 372. Obturator 370 further comprises at least one elongaterigid member 380 extending away from the body member on a side thereofopposite finger contact surfaces 376 and 378, for penetrating through askin surface of a patient.

In the illustrated embodiment, rigid penetrating member 380 is one ofthree parallel elongate rigid members 380, 381, 382 extending away frombody member 372 on a side thereof opposite finger contact surfaces 376and 378, for penetrating through a skin surface. Rigid members 380-382insert into respective downwardly depending tubular leg or fingermembers 318-320 or 358-360 of port assembly 300 (FIG. 37-40) or 340(FIGS. 41-44). Rigid members 380-382 serve to stiffen and hold tubularleg or finger members 318-320 or 358-360 when port assembly 300 or 340is being deployed at the onset of a minimally invasive surgicalprocedure, for example, a laparoscopic or thoracoscopic operation.

Disk or body member 372 is formed along a periphery with one or morecutouts 384 serving as insufflation tube exit paths.

Obturator 370 allows for easy insertion of any trocar or port assemblyhaving three distal leg or finger seals. After the trocar or instrumentport assembly is in place, the obturator is simply pulled out of theport assembly and the minimally invasive laparoscopic or thoracoscopicprocedure can begin.

As shown in FIGS. 48-51, a surgical port assembly 390 comprises a bodymember 392 that includes a rigid conical upper or proximal portion 394and a cylindrical lower or distal portion 396. Cylindrical portion 396is formed along an outer surface with a helical sealing thread or one ormore outwardly extending ribs 398.

Upper or proximal portion 394 is provided along a circular rim 400 witha plurality of suture anchors 402 in the form of substantially flat,upwardly inclined posts for receiving tie-down sutures (not shown) toanchor the trocar port assembly 390 to a patient at an incision site(such as the umbilicus). Upper or proximal portion 394 is additionallyprovided along circular rim 400 with a plurality of rectangular recesses406 for receiving mating projections or keys 374 on obturator bodymember 372 (see FIGS. 45-47).

Surgical port assembly 390 further comprises an elastomeric skirt 408attached to a distal edge of cylindrical portion 396. Skirt 408 providesa protective barrier between laparoscopic instrument shafts (as well astheir operative tips) and abdominal wall tissues. At an upper orproximal end, skirt 408 is formed with a transverse membrane 410provided with a pair of upwardly extending sleeves 412 for receivinglaparoscopic instruments. A downwardly extending third sleeve 414 isprovided for the passage of a scope. Sleeves 412 and 414 are provided atupper ends with circumferential ring seals 416 engageable withinstrument shafts during an operation. In addition, membrane 410 isformed with tricuspid seals 418 at the lower ends of sleeves 412. Sleeve414 also has a tricuspid seal at a lower end.

An insufflation tube 419 with a luer lock 419′ extends inside conicalupper portion 394 and is attached to membrane 410 so as to provide afluid communication pathway therethrough.

As depicted in FIG. 52, a laparoscopic trocar or port assembly 420comprises a body member 422 including a funnel-shaped upper or proximalportion 424 and a cylindrical lower or distal portion 426. Upper orproximal portion 424 is provided along a circular rim 428 with aplurality of suture anchors 430 in the form of substantially flat,upwardly inclined posts with clamping slots or indentations 432 at rim428 for receiving tie-down sutures (not shown) to anchor the trocar portassembly 420 to a patient at an incision site (such as the umbilicus).Upper or proximal portion 424 is additionally provided along circularrim 428 with a plurality of rectangular recesses 434 for receivingprojections or keys 374 of obturator 370 (see FIGS. 45-47). Cylindricalportion 426 is provided along an outer surface with a helical thread orone or more outwardly extending ribs 435 for enhancing a sealed seatingof the cylindrical portion in an incision.

Port assembly 420 further includes, at a bottom or distal end (notseparately enumerated) of cylindrical portion 426, an elastomeric“pants” member 436. Pants member 436 includes a base or cannula carrier438 and tree cannula members in the form of elastomeric legs ordownwardly depending fingers 440 and 442 (only two shown). Two legs 442are each provided with an inwardly extending ring seal (not shown) and atricuspid seal at a lower or distal end 444. Leg 440 is dedicated to thepassage of a scope (not shown) and is provided with a dedicated cannula446 having a tubular member 448 that is inserted into leg 440 and restsat a lower end against a shoulder 448 on an inner surface (notdesignated) of leg 440. At an upper or proximal end, cannula 446 has avalve assembly 450 including a tricuspid seal 452, a ring seal 454, andan insufflation port 456. Cannula 446 may be removably inserted into leg440 and held there by a friction fit.

Legs or fingers 442 may be provided internally with stiffening tubes(not shown) that provide strength and rigidity and reduce friction. Legs442 are flexible at least in a region of attachment to carrier 438,whereby the legs/fingers/cannulas may be temporarily bent into inclinedattitudes in response to forces exerted via laparoscopic instrumentsshafts during a surgical procedure.

As illustrated in drawings described hereinabove, a skirt for a trocaror surgical port assembly for minimally invasive surgery has a 360°circumferential extent. However, it is possible for a trocar or portassembly skirt to extend less than 360° around. This can be particularlyuseful where the trocar or port assembly is purposefully orinadvertently dislodged from a fully inserted position. In that event, apartial skirt with a longitudinal gap or slot can contract and close theslot, thereby permitting further instrument movements while stillproviding protection to abdominal wall tissues.

A partial skirt may provide for a better range of motions than a fullskirt. When instruments are at their extreme lateral positions, a fullskirt may restrict the instruments' movements, while a partial skirtwill not. Moreover, in practice the skirt must be attached (glued, etc.)to the rigid portion of the port. A full skirt will occupy the entirecircumference of the cylindrical portion of the port assembly bodymember, while a partial skirt will occupy only a section of thecylindrical portion. The consequential spatial reduction may besignificant when a small cavity wall incision is necessary or desirable.Finally, a partial skirt might be less expensive to manufacture.

As disclosed herein, a skirt may be used in combination withseal-containing cannulas or fingers that extend either above or belowthe body of a surgical port assembly. In the latter case, one or moredownwardly depending cannulas or leg members may be used in combinationwith a full or partial skirt. The cannulas or fingers may be shortenedwhile still carrying the sealing elements, while the skirt serves thetissue protection function.

A cannula module pursuant to the present disclosure may comprise acannula-carrying member and a plurality of cannulas, fingers, or legsattached thereto. As discussed hereinabove, the carrier member may bedome-shaped above or below the body member of a surgical port assembly.The cannula module may be removably attached to a port assembly bodymember to enable switching of one cannula module with another during asurgical procedure, depending on specific exigencies as they arise.Thus, an “octopus” module with two legs (for a scope and one largerinstrument) could replace a module with three legs or cannulas. When acannula module is removed, the opening in the body member could be usedfor tissue evacuation or other procedure that requires a large accessopening. Pneumoperitoneum is quickly re-established upon connection of anew cannula module. A temporary port plug fitting into the opening ofthe body member (e.g., into a cylindrical portion) may be provided tominimize this inconvenience. A plug minimizes or eliminates gas leakagefrom the abdomen of the patient during an exchange of the instruments.

The present invention can accommodate special hand instruments where theportion of the instrument shaft traversing the port assembly has asmaller diameter than the distal and/or proximal portion. As illustratedin FIG. 53, a laparoscopic instrument 460 includes a handle 462 withactuators or controls 464 and 466 and an elongate shaft 468. Shaft 468includes an enlarged distal end portion 470 incorporating operativecomponents (not shown), a thin middle section 472 and an enlargedproximal portion 474 connected to handle 462. Such a terminally enlargedinstrument 460 can function with a detachable “octopus” with a special“C-shaped” channel. The instrument shaft 468 is sealed between the “C”and the internal wall of the funnel. The smaller diameter cross-sectionof middle section 472 allows one to maximize the range of motion that islimited by the port's internal diameter. Such an instrument 460 canserve to free up as much space in the restricted area as possible. Thelongitudinal cross-section of the instrument shaft 468 has an hour-glass(thin waist) configuration. A seal is established by the instrumentseal(s)—one or several—which are located inside the cannula and hug theinstrument tightly. Since the seals are very flexible, these would notrestrict (seals will be deflected) the movements of the larger diametersections (distal and proximal), but will not allow for gaps between theseals and the central or middle section 472 of the instrument shaft 468.

A surgical port assembly as described herein may be provided with abuilt-in or integrated endoscope 476, as depicted in FIGS. 54 and 55. Adistal portion 478 of a scope arm 480 extending from an underside of aport assembly body member 482 is flexible and incorporates digital chiptechnology such as a charge-coupled device (not shown) at a distal end484. In this design, only a small electrical cable need pass through thebody member 482 of the surgical port assembly at the patient interfaceor skin surface, thereby reducing the scope's impact on the “effective”cross-section of the port and improving on the degree of motion. Thebuilt-in camera is maneuverable via cables (not shown) in the bendableshaft or arm 480. The cables may extend through the port's body member482 to the proximal side thereof. Alternatively, orientation control maybe effectuated wirelessly. In the latter case, a wireless receiver (notshown) may be integrated into the port body member 482 or the distal endportion 478 of scope arm or shaft 480. Motors (not shown) may beprovided in scope arm 480 for bending distal end portion 478 in responseto incoming wireless control signals.

As shown in FIGS. 54 and 55, scope arm or shaft 480 has a proximal endportion 486 that extends along a funnel-shaped portion 488 of bodymember 482 and is permanently or removably connected thereto.Specifically, proximal portion 486 passes through a sleeve 490 attachedto funnel-shaped body portion 488. Alternatively, proximal shaft portion486 may be partially or completely embedded in the wall of funnel-shapedbody portion 488. Proximal shaft portion 486 is connected or connectableto an endoscope functional module 492 that may carry bending actuatorsor control knobs (not illustrated), a light source (not illustrated),electrical cables (not illustrated) for connecting to a video monitor,etc.

An integrated scope as shown in FIGS. 54 and 55 provides the requiredimage using as little space as possible in the space-restricted area,that is, at the patient interface or skin surface. It is to be notedthat rigid laparoscopes with all their straight proximal shaftssubstantial occupy space above the cannula holder or port assembly andthus interfere with the manipulation of “working” instruments. Existingflexible endoscopes do not provide sufficient visualization and are toofragile and too expensive. The design described above with respect toFIGS. 54 and 55 overcome these drawback.

As depicted in FIGS. 56-59, a thoracic surgical port 500 comprises adownwardly tapering, substantially flexible, upper or proximal part 502and an upwardly tapering, substantially flexible lower or distal part504. During use, upper part 502 is located subcutaneously, while lowerpart 504 extends in between the ribs of a patient into a pleural space.A substantially rigid ring-like structure 506 is located, during use ofsurgical port 500, on top of the patient's ribs (not shown). Ringstructure 506 surrounds an interface or junction between upper part 502and lower part 504. Upper part 502 is smaller than lower part 504. Thisallows one to make a smaller skin incision. Lower part 504 is larger andis accommodated in a slightly larger muscle-splitting incision (notshown) between ribs. A flexible membrane 508 is located inside the portat the level of ring structure 506. Membrane 508 must be located in theproximity of the ribs—the restriction zone—in order to maximize therange of instrument freedom. Membrane 508 carries a variety of openings510 for passage of the instruments (not shown). Membrane 508 andmultiple openings 510 are needed (instead of one big opening) to providethe instruments with individual pivot points and individualcompartments. This configuration improves surgeon ergonomics andminimizes the interference of instruments with each other. Rigid ringstructure 506, sitting atop the ribs, provides stability of the port500. Ring structure 506 does not slide into the chest and provides pivotpoints for the instruments. Ring structure 506 sits in a soft tissuepocket created by a surgeon with gentle finger dissection just above thepatient's ribs. Also, in combination with a smaller skin incision, ringstructure 506 eliminates the need for fixing the port 500 to thepatient's chest. Port 500 is mobile but stable in the deployed location.

Ring structure 506 is a part of the entire thoracic port unit 500 anddoes not become detached from the rest of the unit when the unit isinserted in place. Ring structure 506 can be attached to upper part 502and/or lower part 504 or to neither of those parts (attached instead tohorizontal membrane 508), depending on manufacturing needs.

Upper part 502 and lower part 504 can have different durometer values.Upper and lower parts 502 and 504 can have the same flexibility, asimilar flexibility, or a substantially different flexibility dependingon the needs of the operator and the procedure. Upper and lower parts502 and 504 can be permanently glued to one another during manufactureor could be manufactured (molded) as a single integral unit. Upper andlower parts 502 and 504 can be slidably attached to each other. Forexample, (1) lower part 504 may slide into upper part 502, which carriesthe rigid ring 506, (2) upper part 502 may slide into lower part 504,which carries the rigid ring 506, (3) upper and lower parts 502 and 504may slide into a horizontal plate (a rigid membrane 508) that hasopenings 510 for the instruments and is surrounded by the rigid ring506.

In any event, the rigid ring structure 506 sits on top of the patient'sribs. There is no need to fix the port 500 to the surrounding tissues,either with sutures of some other connectors. The port assembly 500 willstay in place.

As depicted in FIG. 59, a rigid ring 512 seated inside a hollow flange514 may form ring structure 506. Flange 514 is continuous with upperpart 502 and membrane 508.

Although the invention has been described in terms of particularembodiments and applications, one of ordinary skill in the art, in lightof this teaching, can generate additional embodiments and modificationswithout departing from the spirit of or exceeding the scope of theclaimed invention. Accordingly, it is to be understood that the drawingsand descriptions herein are proffered by way of example to facilitatecomprehension of the invention and should not be construed to limit thescope thereof.

What is claimed is:
 1. A trocar skirt defining a proximal end and adistal end, comprising: a mounting ring disposed adjacent the proximalend of the trocar skirt; a multiplicity of rigid strips extendingdistally from the mounting ring to define the distal end of the trocarskirt; and a multiplicity of elastomeric strips alternately disposedbetween the multiplicity of rigid strips to support the rigid strips,the multiplicity of elastomeric strips extending distally from themounting ring to the distal end of the trocar skirt, wherein themultiplicity of rigid strips and the multiplicity of elastomeric stripsare arranged in an annular configuration to define a cannula port havingan aperture at the proximal end of the trocar skirt and having anaperture at the distal end of the trocar skirt and a throat area betweenthe proximal end and the distal end, the multiplicity of rigid stripsand the multiplicity of elastomeric strips each defining at least apartial taper between the proximal end of the trocar skirt and thethroat area and at least a partial taper between the throat area and thedistal end of the trocar skirt.
 2. The trocar skirt according to claim1, wherein the multiplicity of rigid strips are pivotably attached tothe mounting ring.
 3. The trocar skirt according to claim 2, furthercomprising a support ring defining the proximal end of the trocar skirtwherein the mounting ring is attached to the support ring.
 4. The trocarskirt according to claim 1, further comprising a support ring definingthe proximal end of the trocar skirt wherein the mounting ring isattached to the support ring.
 5. The trocar skirt according to claim 1,wherein the multiplicity of rigid strips are arranged in an annularconfiguration and are concave in a radially outward direction.
 6. Thetrocar skirt according to claim 1, wherein the mounting ring and themultiplicity of rigid strips are integrally formed from a rigidpolymeric material that is sufficiently thin at connecting points toenable a pivoting motion with respect to the mounting ring.
 7. Thetrocar skirt according to claim 1, wherein the throat area defines anintermediate variable diameter that increases or decreases toaccommodate passage of instruments through the cannula port.
 8. Thetrocar skirt according to claim 1, wherein the multiplicity ofelastomeric strips are angularly or circumferentially spaced portions ofa single web.
 9. The trocar skirt according to claim 1, wherein themultiplicity of elastomeric strips are separate strips.
 10. The trocarskirt according to claim 1, wherein the aperture at the proximal end ofthe trocar skirt and the aperture at the distal end of the trocar skirthave areas that are greater than the throat area between the proximalend and the distal end.
 11. The trocar skirt according to claim 1,wherein a distance of the throat area from the proximal end is such thatthe location of the throat area is configured to coincide with anentrance opening in a patient.
 12. A surgical port assembly comprising:a trocar skirt defining a proximal end and a distal end, the trocarskirt comprising: a mounting ring disposed adjacent the proximal end ofthe trocar skirt; a multiplicity of rigid strips extending distally fromthe mounting ring to define the distal end of the trocar skirt; and amultiplicity of elastomeric strips alternately disposed between themultiplicity of rigid strips to support the rigid strips, themultiplicity of elastomeric strips extending distally from the mountingring to the distal end of the trocar skirt, wherein the multiplicity ofrigid strips and the multiplicity of elastomeric strips are arranged inan annular configuration to define a cannula port having an aperture atthe proximal end of the trocar skirt and having an aperture at thedistal end of the trocar skirt and a throat area between the proximalend and the distal end, the multiplicity of rigid strips and themultiplicity of elastomeric strips each defining at least a partialtaper between the proximal end of the trocar skirt and the throat areaand at least a partial taper between the throat area and the distal endof the trocar skirt.
 13. The surgical port assembly according to claim12, wherein the multiplicity of rigid strips are pivotably attached tothe mounting ring.
 14. The surgical port assembly according to claim 13,further comprising a support ring defining the proximal end of thetrocar skirt wherein the mounting ring is attached to the support ring.15. The surgical port assembly according to claim 12, further comprisinga support ring defining the proximal end of the trocar skirt wherein themounting ring is attached to the support ring.
 16. The surgical portassembly according to claim 12, wherein the multiplicity of rigid stripsare arranged in an annular configuration and are concave in a radiallyoutward direction.
 17. The surgical port assembly according to claim 12,wherein the mounting ring and the multiplicity of rigid strips areintegrally formed from a polymeric material that is sufficiently thin atconnecting points to enable a pivoting motion with respect to themounting ring.
 18. The surgical port assembly according to claim 12,wherein the throat area defines an intermediate variable diameter thatincreases or decreases to accommodate passage of instruments through thecannula port.
 19. The surgical port assembly according to claim 12,wherein the multiplicity of elastomeric strips are angularly orcircumferentially spaced portions of a single web.
 20. The surgical portassembly according to claim 12, wherein the multiplicity of elastomericstrips are separate strips.
 21. The surgical port assembly according toclaim 12, wherein the aperture at the proximal end of the trocar skirtand the aperture at the distal end of the trocar skirt have areas thatare greater than the throat area between the proximal end and the distalend.
 22. The surgical port assembly according to claim 12, wherein adistance of the throat area from the proximal end is such that thelocation of the throat area is configured to coincide with an entranceopening in a patient.